Provider Demographics
NPI:1720124456
Name:ZAKARYAN, GOHAR (DDS)
Entity Type:Individual
Prefix:MRS
First Name:GOHAR
Middle Name:
Last Name:ZAKARYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 BURBANK BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2513
Mailing Address - Country:US
Mailing Address - Phone:818-508-7752
Mailing Address - Fax:
Practice Address - Street 1:10700 BURBANK BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2513
Practice Address - Country:US
Practice Address - Phone:818-508-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB45347-01OtherDENTI-CAL